PubMed · 7232235
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O F Kernberg. 1981. Structural interviewing.. https://pubmed.ncbi.nlm.nih.gov/7232235/
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In a case-finding sample of 1,824 drug abusers in the greater Stockholm area, personality organization (PO), according to Kernberg's theory, was assessed by using a standardized questionnaire, with the clients' contact persons as informants. Twenty percent of the sample were diagnosed as psychotic PO (PPO), 40% had a clear borderline PO (BPO), and 40% a high BPO or a neurotic PO (NPO). This distribution agreed closely with that found in a comparison sample of social service clients. However, in the NPO and BPO groups, the mean scores were higher for the social service clients than for the abusers. A clustering into nine sub-clusters revealed interesting differences within each PO.
The relation of patterns of attachment and psychiatric status was studied in 82 nonpsychotic inpatients and 85 case-matched controls using the Adult Attachment Interview (AAI). AAI transcripts rated (masked to case vs. control status and treatment) were classified using M. Main and R. Goldwyn's (1991) system. Psychiatric patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) I and II structured interviews, were more likely to be classified as preoccupied and unresolved with respect to loss or abuse. On Axis I, anxiety was associated with unresolved status, and AAI scales were able to discriminate depression and eating disorder. On Axis II, borderline personality disorder (BPD) was linked to experience of severe trauma and lack of resolution with respect to it. BPD patients were also rated significantly lower on a scale measuring awareness of mental states. Preliminary outcome results suggest that individuals rated as dismissing on the AAI are more likely to show improvements in psychotherapy.
Paris suggests that some cultures provide protective factors that can suppress the emergence of borderline personality disorder (BPD). Yet all cultures contain some individuals who perceive themselves as unable to meet what is expected of them, and the resultant distress is expressed through a variety of "ethnic" disorders such as susto or nervios. When viewed in this context, BPD is similar to these disorders, notably in the perceived sense of social failure, marginality and powerlessness.